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2013 Virginia Schedule ADJ (Form 760-ADJ) Name(s) as shown on Virginia return Your Social Security Number - - Whole Dollars Only Additions to Federal Adjusted Gross Income 1. Interest on obligations of other states, exempt from federal income tax but not from state tax. ............. 1 2. Other additions to federal adjusted gross income. 2a. FIXED DATE CONFORMITY ADDITION - SEE INSTRUCTIONS. ................................................ 2a 2b - 2c. Refer to the Form 760 instructions for Other Addition Codes. 2b 2c 3 Subtractions from Federal Adjusted Gross Income 4. Income (interest, dividends or gains) from obligations or securities of the U.S. exempt 4 5. Disability income reported as wages (or payments in lieu of wages) on your federal return. 5a. Enter YOUR 5a 5b. Enter SPOUSE’s 5b 6. Other subtractions as provided in instructions. 6a. FIXED DATE CONFORMITY SUBTRACTION - SEE INSTRUCTIONS. ....................................... 6a 6b 6c 6d 7 . , , 00 . , , 00 Enter Addition Amount . , , 00 . , , 00 . , , 00 . , , 00 . , , 00 . , , 00 . , , 00 Enter Subtraction Amount . , , 00 . , , 00 . , , 00 . , , 00 Enter Code Enter Code Deductions from V irginia Adjusted Gross Income 8. Refer to the Form 760 instructions for Deduction Codes. 8a 8b 8c 9. T otal Deductions. Add Lines 8a - 8c. Enter here and on Form 760, Line 12. .......................................... 9 Continue with Line 10 on Page 2. Enter Code Enter Deduction Amount . , , 00 . , , 00 . , , 00 . , , 00 Avoid delays - If completed, attach Schedule ADJ to Form 760. 3. Total Additions. Add Lines 1 and 2a - 2c. Enter here and on Form 760, Line 2. ..................................... from state income tax, but not from federal tax. ..................................................................................... disability subtraction. ................................................................................................. disability subtraction. .......................................................................................... 7. Total Subtractions. Add Lines 4, 5a, 5b and 6a - 6d. Enter here and on Form 760, Line 7. ................... 6b - 6d. Refer to the Form 760 instructions for Other Subtraction Codes. ----------------Page (0) Break---------------- 2013 V irginia Schedule ADJ Page 2 Your Social Security Number - - 2601050 01/13 - - 11. Enter the total number of exemptions reported in the table above. Next, refer to the Poverty 11 12 13. Multiply Line 12 by $300. Enter the result on Line 13 and proceed to Line 14. If you do not qualify for the Tax Credit for Low-Income Individuals but claimed the Earned Income Credit on your federal 13 14. Enter the amount of Earned Income Credit claimed on your federal return. If you did not claim the 14 15 16 17. Compare the amount on Line 16 above to the amount of tax on Line 17 of Form 760 and enter the 17 . , 00 . , 00 . , 00 . , 00 . , 00 18. Addition to tax. Fill in oval if addition came from : 18 19 20 .......... 21 See instructions. 22a 22b 22c 23. If contributing to a Public School Foundation or a Public Library Foundation, enter the code 23a for the foundation(s) and the contribution amount(s) in boxes 23a - 23c. If contributing to more than 3 public school or public library 23b foundations, see Form 760 instructions. 23c 24. Total Adjustments (add Lines 18, 19, 20, 21, 22a -22 c and 23a - 23c). Enter here and on Line 28 of Form 760. .................................................................................... 24 . , , 00 . , , 00 . , , 00 . , , 00 . , 00 . , . , 00 . . , 00 , . 00 . , 00 , . , . 00 , . 00 , . 00 Family VAGI Name Social Security Number Virginia Adjusted Gross Income (V AGI) You Spouse Dependent Dependent 10. Total If more than 6 exemptions, attach schedule listing the name, SSN & VAGI. Enter total Family VAGI here. . , 00 Adjustments and Voluntary Contributions Credit for Low-Income Individuals or Virginia Earned Income Credit Adjustments and V oluntary Contributions . , , 00 Guidelines Table in the Form 760 instructions to see if you qualify for this credit. ................................. 12. If you qualify for this credit, enter the number of personal exemptions reported on your Form 760. ..... return, enter $0 and proceed to Line 14. ................................................................................................ Earned Income Credit on your federal return, enter $0. ......................................................................... 15. Multiply Line 14 by 20% (.20). ................................................................................................................ 16. Enter the greater of Line 13 or Line 15 above ........................................................................................ lesser of the two amounts here and on Line 21 of Form 760. This is your credit amount. ..................... Form 760C Form 760F .... 19. Penalty. Late Filing Penalty Extension Penalty ...................... 20. Interest (interest accrued on the tax you owe). .......................................................................... ....................................................................................................... 21. Consumer’s Use Tax. 22. Voluntary Contributions. Dependent Dependent ----------------Page (1) Break----------------